Karen Rusa was a 30-year-old woman and
the mother of four children. For the past several months Karen had been
experiencing repetitive thoughts that centered around her children's safety. She
frequently found herself imagining that a serious accident had occurred; she was
unable to put these thoughts out of her mind. On one such occasion she imagined
that her son, Alan, had broken his leg playing football at school. There was no
reason to believe that an accident had occurred, but she kept thinking about the
possibility until she finally called the school to see if Alan was all right.
Even after receiving their assurance that he had not been hurt, she described
herself as being somewhat surprised when he later arrived home unharmed. Karen
also noted that her daily routine was seriously hampered by an extensive series
of counting work that she performed throughout each day. Specific numbers had
come to have a special meaning to her; she found that her preoccupation with
these numbers was hampering her ability to perform everyday activities. One
example was grocery shopping. Karen believed that if she selected the first item
on the shelf, something terrible would happen to her oldest child. If she
selected the second item, some unknown disaster would fall on her second child,
and so on for the four children. Karen's preoccupation with numbers extended to
other activities, most notable the pattern in which she smoked cigarettes and
drank coffee. If she had one cigarette; she believed that she had to smoke at
least tour in a row, or one of her children would be harmed in some way. If she
drank one cup of coffee, she felt compelled to drink tour. Karen acknowledged
the unreasonableness of these rules, but, nevertheless, maintained that she felt
more comfortable. When she observed them earnestly, when she was occasionally in
too great a hurry to observe these rules, she experienced considerable anxiety,
in the form of a subjective feeling of dread and fear. She described herself as
tense, uneasy, and unable to relax during these periods. The occurrence of
rarely minor accidents does not reduce her belief that she had been directly
responsible because of her inability to observe the rules about
number.